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22 OSBORNE ST - BUILDING INSPECTION (2) ,L - - ► � GZS °n c 9 ?S1f The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date lied: / a rn Building Official(Print Name) Signature ate 1 SECTION 1:SITE INFORMATION IV a T 1.1 Pfo�erty Ad OS cc 1.2 Assessors Map&Parcel Numbers r l� CI>; ha ram. J�. it to rnc 1.1 a Is this an accepted street?yes_ no Map Number Parcel Number 1 of.3 Zoning Information: 1.4 Property Dimensions.. � ro rn N �— Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard \� Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 wner'ofRecord: i � tfi;.� �AVa 7 ZC 'er� Jce G79 7G Name(Print)tt City,Staattee,,ZIP! No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1,Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other Specify: Brief Description of Propose ork2: ��awl.! ca � SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ /S(JQ ; 1. Building Permit Fee:$ indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑ 3 Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ IS DO . ❑Paid in Full ❑Outstanding Balance Due: Vb K-T c-, SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) S .1 G-7 -7 y r�3 License Number Expiration Date Name of CSL Holder EfIC W. j'.il111 List CSL Type(see below)---(A-- No.and Street Type Description Salem MA 0'1970 U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding I-I 0 �'1 7 I f' C ' SF Solid Fuel Burning Appliances 0 D I I Insulation Telephone Email address D Demolition 5.2 Registered home Improvement Contractor(HIC) ' t4 U M AtlantkWeAef zatinn_1,1-C HIC Registration Number Expiration Date HIC Company Name or HIC R., e Nam A Ue No.and Street o1 Salem MA 01970 Email address City/Town, State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize if-r r j'C Ca !41, to act on my behalf,in all matters relative to work authorized by this building permit application. / ItiLu�.J �atla7�� i ll ZU��/ Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of pepury that all of the information contained in is apip icatlonis tr d accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" SsRe usetts lWanae n:fmm nu ca �a�avemeaat -" aM fle Camtr&ct language to ptat¢themsoPWeeaatesFtomelm ' u•�L�aba5et6 ulaemmers Scak7 ndriroffaoaryal�y Amy aapn h tsr 143A.hutdaesaotindodeafao Caastm'Guitkm Aam* O�ceofCanHon,q{tghsaMova�uRafi®§Caas�eron�Eionm61�-3-8v�i(�j 1q�ah�d'na@�� 6� A� easssrn d11•athe, °"re Cantrac(or:'Information even mvwshvn sue i 7''1 . Campsa . Addrz¢(donetomaPoa O amcedd Z Za. CaawamlSatelpesnd ' Will i. i' . mffvnn T ,y - 4Cods �awtimat,iddrea �v Ave& 67 7� (amt ' Rom] iimePitoae -- = ErahieePbi+e hlaiGne.W S state LPCcde -� d1.t(hdi6tentfam abore) j O awsioasPGme Federal _ tl �°.amvu..avas. ��•+� u3 ftl Numbs The Cm ;�a.i-•,m`a�mR veoe� sex (Daev3e is dmiragl�s to do thetoaoaiaguLytfarNteFiomaomter. demldmwad:m msalum.spm'ty�gtye�ymvd'°1d3tr3eafmuoiats tnha - Required Peeratts-Tbefo andsgllbo a°n'bgbmldmPPamitsacte9�ad PmPasel Starcaml Ca(Ownets Who ofithecootraetmasUtehomemwetsagot 6eadh MvwaaSrbedak-Thefallo'viogr _adole�nL- esgladed from ��eir own perndts Spill be � eWm®Icsschcte"Reemb.Fseadihe s42GL chap terI4� araniyFundpmvaionsaf -�---L�Date ! coaaactos'scouaoladse nben canbattm{nill begin conoacted n�dL Total Contra' )-�Z'/3 D"etvheom The Conoaavr Rraaand Pn➢mwtsrhelule naaetainmknrllbestlbgaodaayemmpkteeL eta ptafo®thesmdt frajisb themaledd®dtabor .. SSimadeaacoNianlothefdim+ gsdeadde; speeigedabovatbrthe mtd s»moe - upon aembtgemttraa(ME to eI'axed is ofthe tedd S co!taae[prire g tba - a vm compi�aa aF �Of� mderita¢C sNdebe a sg eaa) �•�'-e�/ n n o�orvpoa f Pledm off . aoluvedof the ma I ull upon tre4 ((zvrtotbidsdemaadut �e �my �O�� �sp� S Sfitl7 pa}mmttmW oauaact is' i1Pletedto bothPatty'ssadsfaedaa) t°mendmmmalamn �W��ineniv �1p. toidl� � � j f igOTh-$-('I btctu&ag as fi I S IL4drp ' not ew`[d— ibe9ptVat fa)®ntywt ld'9tmea thataa•depwvl wrdatm � w9icheaaa bespecgyantrtaimodsan¢Malbecpppleu- spend MHouta ssw eal C. k aawty Igiaa seb 4mom SabL9atra'a12-The pmn%nb con anpar mauamar mbesotdp eespon9ylefor ° Yesra rt K t an ual d�'thecoatranan The eoatmaorfmlheryg O OFL oumlydesvibed>egat�ea oFthe M e t Con eletA1 YresP tRuibefaraa' IRRhRI°°Y WiN conuan shall 'Poo mEaiaA d Payments to ell snbtonaaetoErd +rap&tbataaS'fren orotha5ertui6'IDhtgsbtsbI coaazuunderlm¢--.I Oeisalhanrisen sarefidly before sigdvgtbis coma¢ Pilloul an(heredd no vnlLindtiseioLmaent•the �QvWefallowiag eavdmtsmidnotiees ° Donh be Petaaned mtosigmag the ° Lelasmath coaaant7*akedmemteadaadfoll•and snbemtoaaots� li t rh D- tnm+vvemrnttr } mslan Th Ask4uesdans ifsma ree"Oodoa l»utidarePa[ereo n+thrbeDvecmrofA Omaha pmaxmen- ''s.The lalvnetuhumduhomeM'gtsmGea ° smanwevnoiaattarhavel ram aAsk theCooaa m farW"7i70- Rl ollift orly•�g GORL 77�39/� g emsmd ' Knmv}mvl- I - 00gpm-°f°'madmsodmtnacm flnsend oL�� }m ciddetotfieH a mVel9hilider. Kariba Pattcol CQIVRSgaraskm otn hvPtavemenI ContworLms''. o� ononthenhwmSideofthis form Rodger You ena}• f copy III cone an conbcancel thisygeeeco(�itbas !0rdbusiumridogat his/herma(nOMMOtmmach nI Ethan the aant2ctatsnarmd face ebicd 6udtress t6y faamtia dtesi blxech°fdre 6}•oNmm}•moi)posted,bptd_ P ofbusmess,tutsvieted DQNOTSItr`NTFSf$CmLSathezaadtednodmafmaCd,admtfmmfrdauespleoreoyoao�mm/dmSbtoftha cepr Tnn 6taLJmRmafdeearaeaE ++ 'aC AREA � o tb11 L c =ems oo-o .��memc�u �PACESTit the [fatttcontler'sstgaaaay, caaaaerar'asigamaR Date Dam llla� Il�1 Contractor Arbitration The Home improvementconuacJgri�wprovideshomeowners�vitittherightmiaisateana�bi afforded ma atter6inive m coin action)ifthay have a disputetvrtH a contractor The same ii3ht '3�— maticalL contracto4howaver Thecurumetorsauldhue10resolveanydiisputeltalshehasWithahommtvaerincourtunless both parties We to the optional citise providedbelow.This clause would eve the tophactor the same rightto arbitration as is affordedto thehomentvtterby the Home hnmovement ContractorLat C. The contractor and the homeonaer he aby mutually agree in advance that in the eseptithe contrctor has a dispute concerning this connaet,the contractor may submit the dispute m a private arb' oaad he consumer shall bWch has been e required the Secretary of the.E4ecutive Of hfd of ConsnmerAffairs and Business Regulation?A. to submit to such arbitration.aMpM4iledla viassachusetts General Laws,chapter 14 �xr ,r✓ 7�aulaZT� a :� 3 Homeo.mefs Signature Contrabtoi's Si. ture kOTICL:The signatures oFthe patties above apply only to the agraeinem of the p�pes to altetaative dispute resolution initiated by the contractor'; The homeownler may initiate alternat a dispia resolution ever Where this section is not separately signed by rile parties. Homeowner's Rights tar 142A)and other constaner A hpmeo.wnet s righisunder the Hotpe Improvement Caned in r Iry y,e a by amanmem However,homeowners protection laws(i.e.MGL chapter 93A)may not be waived in any Aa, may be excluded from certain ri"_htsifthe contractor they choose is not properly ragstered as prescribed by law. Homeowners who secure their prim building pemrits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Lau. The cantractoris re'Donsnble for completing the nmik as described:in a timely and nvrkmaalils manner Homeowners may be entitled to other specific legal rights if the contractor =_uorantees or provides an express wetranty for.voliaranship or materials. In addition to guarantees or warranties provided by the contractor al[goods sold in Messachntseps cam,an implied viW9ty ofinerchantabilttyand fitness for a Particular purpose. An enumeration of othermatsrs on which the homeowner and contractorlawfplly Wee may be ct a wner' added r the terms of the contract as;limit as they d contact the Consumer Infamnehgfron Hotlm(listed below). have questions about your constanadhomeoirnerrights Execution of Contract .Jr all exhibits and referenced The contract mustbe executed in t cos and should not be sued until a cop.' r documents have been attached. Parries are also advised not to sign the document until all blankseetions have been filled in ormarlsd as void,deleted'.or not applicable. One original signed cop"of the contract.mdth attachments is to be given to the owner and the other,Ispt by the contracmr• 'arty andifiaationto the original d a fully wz cu a itcopy Oft and a_rseed to by both parties•Conaracied workmay aotbegi a until both parties I ve received a fully executed copy of the contract and the three day rescission period has expired Accelerated Payments A contractor may not demand payments in advance of the dates specified on the p ayment schedule in cases where the homeowner deems biadherself to be financially iMecum Ho.evec in irtstances-mere a contractor deems bimfnerself to be financially insecure the contractor may rev".that the balance of funds notzxt due be placed in a joincescrow account as a prerequisite to continuing the contracted wink-. Nnthdraaal of nmdsi from said account w.nutd require the . signatures orboth parties. Additional Information if you have general questions orneed additional information about the Home Iml rovement Contractor Law or Other consumer rights,or if you wish toobtain a free copy of "_4 Massachusetls Consnaner Guide to Rome TmpravemanY' contact: - Comamer lnfori nation online Office of Consumer Af*s and Business Regulation i 10 ParkPlam Room 5170,Boston MA 02116 y' 617-973-8787,SSG-28337i7orvisittheOCABRwebsiteat"'^: Ifyou ivantto verify the regEsuathn of a contractor or if you have questions°-need additional information specifically about the contractor registration component of the Hama improvement contrac i Lair;contact: lhiacror of Home Improvemeat ContractorRa�shano° Office of Consumer Affairs and Business Resulafton 10 park Plaza,Room 5170,Boston MA 02116 617973-8787,588-M3757Or visit the HICwxbsite'at. e_:rz': s RemsGatiom Go online w wieivthe stems of aflame improvement Contractor Farassistance.vnh informal mediation ofdisputes or to register fbrinW com, was against a business call: Consumer Complaint Section office of the Attorney General 617-T37-8-400 AND/OR BettarBusinessBurem 508.653-4800,509.755-2548or413-734,31.14 �: ,,.rr MID r:v The�Cornmortwealth ofMassachusetts Department ofllzdustrla1Accidents Office ofdftvestigations 1 Congress Street, Suite 100 Boston,MA 02II4-2017 Workers' Compensation Insurance Affidavit: B A Iicant Ynformaiion uRd g/Contractors/ElectriciansMlumbers in Name (Business/OrganiratioMndividuat): '�C{f7'� Please Pr t Le 'bl y[ l�t1r.,.LL r Address: City/State/Zi !I/91-7 D Phone#: 9?09-• 71-/�/ /y Arse yo employer?Check the appropriate bog; 1•� t am a employer with 4, 1 am a Type of project(re employees general contractor and I (required (full and/or art-time). have hired the sub-contractors 6, ❑New construction 2,0 I am a sole proprietor or partner- listed on the attached sheet ship and have no employees These sub-contractors have Y" 0 modeling working for me in any capacity. employees and have workers' 8- 0 Demolition [No workers' comp,insurance comp.insurance.t 9. 0 Building addition required.) 5. 0 We are a corporation and its _ 10.[f Electrical re 3.❑ I am a homeowner doing all work officers have exercised their Pairs or additions myself. (No),vorkers' corn P. right of exemption 11'0 Plumbing repairs or additions insurance r P n pn per MGL m egtrrred j t c. 152,§1(4),and we have no 12.0 Roof repairs employees. [No workers' 13.[DIII ry Q ''�cr VI `Any applicant that checkscomp.insurance required.] box nl must also fill om the sw4oau belo.11 howm Homeowners who submit this affidavit indicating g their workers'compensation policy infmmeGon_ 'Conttacturs that check this box must �g they.are do all work and then him outside contractors must submit atmched an a g employees. If the sub-con dhey mul sheet showing the name ofthe sub•contr anew at—ndavit indicating such. tractors have employees,they must pmvide their workers' o�and' whether or not those entities have I am an em p 8P•Policy number. ployer that is rotridin workers'compi anon insurance for my employees Below is the policy and fob site inforrnatiorr, Insurance Company Name: rt,rr e Policy R orSelf-ins.Lit..r� �-7 0 Job Site Address J� Expiration Date: 3Io2O�/j 2 2- G S'6 , 1 Attach a wCity/State/Zip: Sq I•Pn,.� — PY of the workers,compensation policy declaration page(showing the policy number and Failure to secure coverage as required under Seetionl25A ofMGL a 152 can lead to the im fine up to$1,500.00 and/or one expiration datea Of up to S250.00 a dayYear imprisonment as well as ropy penalties in theform of a STOP WORKcRDERR tiesand a fine Irlvesu against the violator. Be advised that a copy of this statement may be forwarded to the Office of gations of the DIA for Insurance covers e ve rification.erification. I do hereb cerfi der the irts a awes o er my that the in Si formation provided above is true and correct. afore: _- _ E�N'�r—s' —1 '�— '9 7 7G/L/- /L/ I --- Date: L Po e9: 3 _ Official use only. Do nor rurite fn this area to be com pleted by city or town official City or Town; Issuing Authors Per•mit/Licemw# t9(circle one): 1-Board of Health 2.Building Department 3.Ci/'Town Clerk 4.Electrical Inspector 5.plumbing Inspector Phone#: ITHOLDER. THIS HIS CERTIFICATE IST ISSUED AS A IEATTER OF 1NFORRIATION ONLY AND GDHFERS NO RIGHTS UPON THE C� AFFORDED @Y TFEE Pp�,�I BEL04+H07T,,SFCER11FICATE OF INSURANCE DOES NOT EXTENDCONSTI ORUTE A CONTRACT , THE ISSUING INSURERS AUTHOR17 AIr1END, EXTEND OR ALTER 'HE CO ERAGE I )r _ED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. SET WEEN I he not coRtty IMPORTANT: smsand conditions Of thcate,holder i's eme Policy,certain c esDmaY rthe equire an)must be endorsed. IfSUBI eadorsemenL A statement ROGATION i cats does' I not corder rights to the certificate holder in rreu Of such a dorsemerd(s). I paowc� ' IEASTERN INS GROUP LLC CcrrrAcr e33 4YEST CENTRAL S- ruti_ NATICK.MA 01760 A X AZ W a1; IIAOC N r i INSUREJI(S)AFFCXX IG COVERAGE LVSURERA:A I LVSL'AEp ME.41CA- RICHINSU,4gryCE CCNPANY NAIL_ , ATLANTIC WEATHERIZATION LLC INSURERB: I 61 REAR JEFFFERSON AVE SALEM.MA 01E70. INSURER C: INSUAEA D: I fINSURER E: O E 1 IN$URE4?: , I THIS IS C FIC T g ABOVE CERTFY THAT THE POLICIES OF INSURANCE 0 - FOR THE POLICY PERIOD INDICATED- NOTWITHSTANDING LISTED HAVE BEEN ISSUED TO CONi RAC-OR OTHER DOCUMENT WITH RESPECT HSTANDING ANY REQUIREMENT, TERM THE INSURED NAA,Ep ! INSURANCE AFFORDED BY THE POLICIES TO NCH THIS CERTIFICATE MAY BE ISSUED OR RCONDITION OF ANY CONDITIONS OF SUCH POLICIES.LIMITS SHOWN NM ISBEEN REDUCED BED HEREINIS SUBJ:CT PTO r MAY PERTAIN, THE I D1sRAl THE TERNIS, EXCLUSIONS AND LTA I�'FEOFINSURANCE ADD SDB�e BYPg1pCLAIMS- O ERALLWSILrrY i S 1V DII POUCYNuuaan POUCYEFP POLICYE`•p I IMk/OQ AV.L �O`-'t"ERQAL GeYEPaL L1A31L/rY EACHU_'CUR w� 1 e IC(AIELS'-l;,ADE 1 RENCE $ CCJ �R y 1 OAMAGCCTORaEatVr IS r n I I MSD EXP rplly one7Rraan7 $ I G'h7AGGRMAT_ I FERSOIiAL B AoVINJ1RY $PLR+rt APP ear I M FROGGY l JEOC �PER. I RAI-AQG.4EOAT S A O.-AOBRE UABERY LOG 1 FRODUCTS-COMPMPAGG $ _ANYAUTO I S IAA ;r-a ASVROE0UL0 f'aW.AKSINGLEUtiff S HIRED AUTOS NQV-0NIVCD ! EODILY INIURY IF.Pernnl ,$ AUTDS I I EMILY ISIURY(Per eyeem7 I S I P4O� R UMBREUA LIA9 OCCUR 'l:AGE $ I I EEXCSS UAS S IDEDI A_ Cinl.tS+IADE 61CH OCCURRENCE S I -TENTION- I AQGREQATE � I Ylre pac a COIApaNSST10N ANOELIPLOYERS'LIAA-N61L1TY f I$ O;:;PsOPAIeI O+LaAATNEFUEI(ECVrNSY?J •- I lTC5:AT7r- Pje?wRG4@.,jER EXCLUDE IRIi NfA � !TORYL^..IT; 1 1'reR'SCyfn Kit) Ll uT-;�"�ea�G1 aB2us21 03-20-2014 03.20.201a EL aACFi ACCIDENT SDO,OOD IRnQ,V FEAATLWS} EL 06EASE-EAEMFLOYEEI - 0.000 I a 06EASE-P61CYLOdrt $500.000 I DESCRIPnON OF OPERATIONS!LOCATIONS) 1 VENICLS(AltaeII ACCORD 101,AtlQI9nxl RCmeNe SshetlCAe,Umnrsi WLsreAWred) I I � 1 CC TIF C 0 ER OI-1.OF SALEM C NCELLATIO I S3tirASHINGTONST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SEj SAIEM.MA 01970 CANCELLED BEFORE THE EXptRAT10N DATE jNOTICE MOLL BE DELIVERED IN THEREOF,' JI !POLICY PROVISIONS. ACCORDANCE Y�ITH -1HEt I !ALTHORRM REpRSENTATIV-C I e AV Cg ACORD 26(2010/07 ig88.2010 ACORD CORPORATION. The ACGRD name and logo are regi ©stered marks Of ACORD A0 rights reserved. • OF THIS CERTIFICATE IS ISSUED q � ��`��� noN oN�Lv�gNO coRsNSUNCE ILI CERTIFICATE DOES NOT AFFl DATE Man BELOW, THIS CER'RpICATE OrnNCERDOESANOT CONSTITUTE A CON NO RIGHTS UPON THE CERTIFICATE3/10/2014 REPRESENTATIVE OR PRODUC 6KTEND OR AL TBR THE COVERAGE AFFORDED By HOLDER, THIS IMPORTANT: c the eertffica}e hD01 A S all AUDITIONAL INSURED,OLR CT B RDED BY THE PO{IZED the terms and conditions of the policy,certain pDllcies may require an endorsement q s ETWEEN THE ISSUING INSURER(S), AUTHORIZED the policy(ies)just be endorsed. If SUBROGATION IS iNA1VED,subject to Call holder in lieu of such endoraement(s}, PRODUCER tatement on this certtf3cate does not confer rights Eastern Insurance I CONrA 9lrts to the 233 West Group T�+C i Name Coastrual Central Sire@t PHONE ((5D8)651-7700 Natick AEOADaa Fy INSURED 017601 INSURER 1NSURERA ) AFFORDING COVERAGE Atlantic Gteatherization I e]1a Protection Ins. Co- NAICR 61 Rear 1"s°tea-fella Indemai 136 Jefferson ATrenue INSU CNautilUS Ins IAS Co. 00'17 Salem wsuRERo• uranae Co COVERAGES 019701 INsuRER s: rHls Is TO cERn� 'CERi7FICATENUMBER3taster NSURER P: INDICATED. NO THAT THE POLICIES OP INSURANCE U 2026 CERTIFICATE TWITHSTANDING ANY REpUIREMENT, STED BELOW HAVE BEEN ISSUED TO THE tNSURER�SION NUMBER. MAY BE ISSUED OR MAY PERTAIN. THEW ROANCE AD ORDEDF B THE POL CITES DEOTH BED HERE1 SUBJECT TO ALL THE IXCLUSIONS AND CONDInONS OF SUCH POLICIES.LIMflS SHOWN MAY HAVE g NAMED ABOVE FOR THE POLICY p IN WITH RESPECT PERIOD L TTPE OFINSURANCE TO WHICH THIS GENERAL UABILI7Y t REDUCED'.BY PAID CLAIMS- P TERMS, PDUC NUMBER Pop EF.F LIC X co41lAERCWLGENERALLUaILm ` usHrs DLAIM3�.iADE EACH OCCURRENC. ®OCCUR S00042826 S 1,000,000 a /20/2014 /20/2015 Isis I S 50,000 MED EXP( one ) S GEN•L AGGR PERSONALAApV INJURY S,OOO EGATE DMITAPPLIE9 PER; s 1,000,000 Policy X P$0. lOC i GENERAL AGGREGATE S 2,000,000 AUTOLi081LE LIA91LnY PRODUCTS.C061PKIP pGG S $ ANY AUTO ' 2,000,000 AUTOS PoED X SCHEDULED- Ea BINEO SIN LIMIT S ASCUMSS ne HIREDAUTOS X VANED i 02003E871 /20/2014 BODILY INJURY 1per T• 000 000 /20/2016 BODILY INJURY/Per acl 111 S X UMBRELLA UA9 X PROPER D E EXCESS LIAB OCCUR raxid SCLAQAS.' PIP SKI, S D` AAD- 8 000 EACH Ol RETEnmovsENCE s 1,000,000 WORKERS COMPENSATION 60005B659 AGGRECg7E AND pRPLOYERS'LIABILnY /20/2014 /20/2013 ���— S 1,000,000 ANY PROPRI I S O.TICeRRAEh goE ARTNERr2%Egln1,E YfN Aim STATU. (Ma"Quaryinl -D7 NIA OTH D_SCRIPnON a-O S.L.EACHACCIDENi S PERATIONa'pryan C POLLATION LI)tBILITY E.LDISEASE-EAEMPLo S . 00378602 0/1/2013 O EL DISEASE-POLICY UrAT S i/1/2014 GENERALAGGREGATE DESCRIPTION OFOPERAnONSl LOCATIONS IVEHICLES , I _A POLLUTION CONDITION $1,000,DO0 IABsen ACORD tot,w4ei8onel RemerkaS $1,000,000 ehetlUle,VmPte spade fs}eq�Ulran) I ER71FICATE HOLDS CANCELLg77ON OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCE aar.>a>.„ THE EXPIRATION DATE THEREOF, NOTICE WILL Be LLED BEFORE 9car=Wu % 01 STREET- ACCORDANCE VIIlfFf THE POLICY PROVISIONS. DELIVERED IN ! � 01970 AUTHOR®Rep RESENTATNE ORD 26(2010,05) i Ronald Clealg � 0?S,amnrtom j /'� - Ttie dCA'IR(1 mmu and IMn aro p O 1988-2010 ACORD CORPO —�•.:nN'efnred m 'Ira„f arnrpn RATION. All rights reserved. Massachusetts-Departments;public Safety Board of Building Regulations and Standards Construction Supe-W 77 License: CS-087977 ERIC W PALM = 3 TONST Salem 01m MA 01970- D 92r � ,.:� Expiration Commissioner 04f=016 P nuirorrmunl(�o' G�j�irttnck"C/b#ceorCooso"tA fTairs&Bosmess RegaafionMEWIPROVEENT CONTRACTORtratlon: 142089TYPlrafion: 3/1212f)16. Ltd Liability Corpo', ATLANTIC WEATHERIZATION L.L.C. ERIC PALM - 61RJEFFERSONAVE - SALEM,MA01970- Undersecretary